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Mortier P, Amigo F, Bhargav M, Conde S, Ferrer M, Flygare O, Kizilaslan B, Latorre Moreno L, Leis A, Mayer MA, Pérez-Sola V, Portillo-Van Diest A, Ramírez-Anguita JM, Sanz F, Vilagut G, Alonso J, Mehlum L, Arensman E, Bjureberg J, Pastor M, Qin P. Developing a clinical decision support system software prototype that assists in the management of patients with self-harm in the emergency department: protocol of the PERMANENS project. BMC Psychiatry 2024; 24:220. [PMID: 38509500 PMCID: PMC10956300 DOI: 10.1186/s12888-024-05659-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 03/05/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Self-harm presents a significant public health challenge. Emergency departments (EDs) are crucial healthcare settings in managing self-harm, but clinician uncertainty in risk assessment may contribute to ineffective care. Clinical Decision Support Systems (CDSSs) show promise in enhancing care processes, but their effective implementation in self-harm management remains unexplored. METHODS PERMANENS comprises a combination of methodologies and study designs aimed at developing a CDSS prototype that assists clinicians in the personalized assessment and management of ED patients presenting with self-harm. Ensemble prediction models will be constructed by applying machine learning techniques on electronic registry data from four sites, i.e., Catalonia (Spain), Ireland, Norway, and Sweden. These models will predict key adverse outcomes including self-harm repetition, suicide, premature death, and lack of post-discharge care. Available registry data include routinely collected electronic health record data, mortality data, and administrative data, and will be harmonized using the OMOP Common Data Model, ensuring consistency in terminologies, vocabularies and coding schemes. A clinical knowledge base of effective suicide prevention interventions will be developed rooted in a systematic review of clinical practice guidelines, including quality assessment of guidelines using the AGREE II tool. The CDSS software prototype will include a backend that integrates the prediction models and the clinical knowledge base to enable accurate patient risk stratification and subsequent intervention allocation. The CDSS frontend will enable personalized risk assessment and will provide tailored treatment plans, following a tiered evidence-based approach. Implementation research will ensure the CDSS' practical functionality and feasibility, and will include periodic meetings with user-advisory groups, mixed-methods research to identify currently unmet needs in self-harm risk assessment, and small-scale usability testing of the CDSS prototype software. DISCUSSION Through the development of the proposed CDSS software prototype, PERMANENS aims to standardize care, enhance clinician confidence, improve patient satisfaction, and increase treatment compliance. The routine integration of CDSS for self-harm risk assessment within healthcare systems holds significant potential in effectively reducing suicide mortality rates by facilitating personalized and timely delivery of effective interventions on a large scale for individuals at risk of suicide.
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Grants
- AC22/00006; AC22/00045 Instituto de Salud Carlos III (ISCIII) and by the European Union NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia
- AC22/00006; AC22/00045 Instituto de Salud Carlos III (ISCIII) and by the European Union NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia
- AC22/00006; AC22/00045 Instituto de Salud Carlos III (ISCIII) and by the European Union NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia
- AC22/00006; AC22/00045 Instituto de Salud Carlos III (ISCIII) and by the European Union NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia
- AC22/00006; AC22/00045 Instituto de Salud Carlos III (ISCIII) and by the European Union NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia
- AC22/00006; AC22/00045 Instituto de Salud Carlos III (ISCIII) and by the European Union NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia
- AC22/00006; AC22/00045 Instituto de Salud Carlos III (ISCIII) and by the European Union NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia
- AC22/00006; AC22/00045 Instituto de Salud Carlos III (ISCIII) and by the European Union NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia
- AC22/00006; AC22/00045 Instituto de Salud Carlos III (ISCIII) and by the European Union NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia
- AC22/00006; AC22/00045 Instituto de Salud Carlos III (ISCIII) and by the European Union NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia
- AC22/00006; AC22/00045 Instituto de Salud Carlos III (ISCIII) and by the European Union NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia
- ESF+; CP21/00078 ISCIII-FSE Miguel Servet co-funded by the European Social Fund Plus
- PI22/00107 ISCIII and co-funded by the European Union
- PI22/00107 ISCIII and co-funded by the European Union
- PI22/00107 ISCIII and co-funded by the European Union
- 202220-30-31 Fundación la Marató de TV3
- 202220-30-31 Fundación la Marató de TV3
- 202220-30-31 Fundación la Marató de TV3
- 202220-30-31 Fundación la Marató de TV3
- 202220-30-31 Fundación la Marató de TV3
- 202220-30-31 Fundación la Marató de TV3
- 202220-30-31 Fundación la Marató de TV3
- 202220-30-31 Fundación la Marató de TV3
- FI23/00004 PFIS ISCIII
- FI23/00004 PFIS ISCIII
- SGR 00624 the Secretaria d'Universitats i Recerca del Departament d'Economia i Coneixement of the Generalitat de Catalunya AGAUR 2021
- SGR 00624 the Secretaria d'Universitats i Recerca del Departament d'Economia i Coneixement of the Generalitat de Catalunya AGAUR 2021
- SGR 00624 the Secretaria d'Universitats i Recerca del Departament d'Economia i Coneixement of the Generalitat de Catalunya AGAUR 2021
- SGR 00624 the Secretaria d'Universitats i Recerca del Departament d'Economia i Coneixement of the Generalitat de Catalunya AGAUR 2021
- SGR 00624 the Secretaria d'Universitats i Recerca del Departament d'Economia i Coneixement of the Generalitat de Catalunya AGAUR 2021
- SGR 00624 the Secretaria d'Universitats i Recerca del Departament d'Economia i Coneixement of the Generalitat de Catalunya AGAUR 2021
- SGR 00624 the Secretaria d'Universitats i Recerca del Departament d'Economia i Coneixement of the Generalitat de Catalunya AGAUR 2021
- SGR 00624 the Secretaria d'Universitats i Recerca del Departament d'Economia i Coneixement of the Generalitat de Catalunya AGAUR 2021
- CIBERESP; CB06/02/0046 CIBER of Epidemiology & Public Health
- CIBERESP; CB06/02/0046 CIBER of Epidemiology & Public Health
- CIBERESP; CB06/02/0046 CIBER of Epidemiology & Public Health
- CIBERESP; CB06/02/0046 CIBER of Epidemiology & Public Health
- CIBERESP; CB06/02/0046 CIBER of Epidemiology & Public Health
- CIBERESP; CB06/02/0046 CIBER of Epidemiology & Public Health
- ERAPERMED2022 the Health Research Board Ireland
- ERAPERMED2022 the Health Research Board Ireland
- no. 2022-00549 the Swedish Innovation Agency
- no. 2022-00549 the Swedish Innovation Agency
- project no. 342386 the Research Council of Norway
- project no. 342386 the Research Council of Norway
- project no. 342386 the Research Council of Norway
- the Secretaria d’Universitats i Recerca del Departament d’Economia i Coneixement of the Generalitat de Catalunya AGAUR 2021
- CIBER of Epidemiology & Public Health
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Affiliation(s)
- Philippe Mortier
- Hospital del Mar Research Institute, Barcelona Biomedical Research Park (PRBB), Carrer Doctor Aiguader, 88, 08003, Barcelona, Spain.
- CIBER of Epidemiology and Public Health, Carlos III Health Institute (CIBERESP, ISCIII), Madrid, Spain.
| | - Franco Amigo
- Hospital del Mar Research Institute, Barcelona Biomedical Research Park (PRBB), Carrer Doctor Aiguader, 88, 08003, Barcelona, Spain
- CIBER of Epidemiology and Public Health, Carlos III Health Institute (CIBERESP, ISCIII), Madrid, Spain
| | - Madhav Bhargav
- School of Public Health & National Suicide Research Foundation, University College Cork, Cork, Ireland
| | - Susana Conde
- Hospital del Mar Research Institute, Barcelona Biomedical Research Park (PRBB), Carrer Doctor Aiguader, 88, 08003, Barcelona, Spain
| | - Montse Ferrer
- Hospital del Mar Research Institute, Barcelona Biomedical Research Park (PRBB), Carrer Doctor Aiguader, 88, 08003, Barcelona, Spain
- CIBER of Epidemiology and Public Health, Carlos III Health Institute (CIBERESP, ISCIII), Madrid, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Oskar Flygare
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Sweden
| | - Busenur Kizilaslan
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Laura Latorre Moreno
- Hospital del Mar Research Institute, Barcelona Biomedical Research Park (PRBB), Carrer Doctor Aiguader, 88, 08003, Barcelona, Spain
| | - Angela Leis
- Research Programme on Biomedical Informatics (GRIB), Hospital del Mar Research Institute, Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Miguel Angel Mayer
- Research Programme on Biomedical Informatics (GRIB), Hospital del Mar Research Institute, Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Víctor Pérez-Sola
- Neuropsychiatry and Drug Addiction Institute, Barcelona MAR Health Park Consortium PSMAR, Barcelona, Spain
- CIBER of Mental Health and Carlos III Health Institute (CIBERSAM, ISCIII), Madrid, Spain
- Department of Paediatrics, Obstetrics and Gynaecology and Preventive Medicine and Public Health Department, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Ana Portillo-Van Diest
- Hospital del Mar Research Institute, Barcelona Biomedical Research Park (PRBB), Carrer Doctor Aiguader, 88, 08003, Barcelona, Spain
- CIBER of Epidemiology and Public Health, Carlos III Health Institute (CIBERESP, ISCIII), Madrid, Spain
| | - Juan Manuel Ramírez-Anguita
- Research Programme on Biomedical Informatics (GRIB), Hospital del Mar Research Institute, Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Ferran Sanz
- Research Programme on Biomedical Informatics (GRIB), Hospital del Mar Research Institute, Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
- National Bioinformatics Institute - ELIXIR-ES (IMPaCT-Data-ISCIII), Barcelona, Spain
| | - Gemma Vilagut
- Hospital del Mar Research Institute, Barcelona Biomedical Research Park (PRBB), Carrer Doctor Aiguader, 88, 08003, Barcelona, Spain
- CIBER of Epidemiology and Public Health, Carlos III Health Institute (CIBERESP, ISCIII), Madrid, Spain
| | - Jordi Alonso
- Hospital del Mar Research Institute, Barcelona Biomedical Research Park (PRBB), Carrer Doctor Aiguader, 88, 08003, Barcelona, Spain
- CIBER of Epidemiology and Public Health, Carlos III Health Institute (CIBERESP, ISCIII), Madrid, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Lars Mehlum
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ella Arensman
- School of Public Health & National Suicide Research Foundation, University College Cork, Cork, Ireland
| | - Johan Bjureberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Sweden
| | - Manuel Pastor
- Research Programme on Biomedical Informatics (GRIB), Hospital del Mar Research Institute, Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Ping Qin
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Hussein MA, Nallani R, Jenkins PM, Haake RS, Perinjelil V, Cranford J, Campbell A, Dryden A, Kenney S, Herdman K, Dombrowski A, Sachwani-Daswani G. The role of trauma services in intentional self-harm at a regional level 1 trauma center. Injury 2023; 54:110981. [PMID: 37596120 DOI: 10.1016/j.injury.2023.110981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 08/02/2023] [Accepted: 08/05/2023] [Indexed: 08/20/2023]
Abstract
INTRODUCTION Suicide claims many lives globally, each year. For every person that dies by suicide, multitudes more attempt it. A national shortage of psychiatrists may prevent many individuals from receiving timely mental health care. For many individuals, the primary entry point into the healthcare system is through the emergency department. The trauma service frequently treats patients with severe self-inflicted injuries and for many this is not the first time. This represents an opportunity for intervention to disrupt the cycle and prevent future death. METHODS We conducted a retrospective chart review of all patients with self-inflicted injuries, admitted to the trauma surgery service between 2012 and 2021. All patients above 10 years old were included. RESULTS Four hundred forty-one patients were admitted due to self-injurious behavior in the period under study. The majority of patients (71.9%) had a pre-existing mental health disorder. Fifty six patients suffered fatal injuries; the majority were White (78.6%), males (80.3%), and were inflicted by gunshot (71.4%). Nearly one third of patients with self-inflicted injuries had a history of self-injurious behavior with the average number of attempts being 2.7 (SD: ±3.8). CONCLUSIONS We need interdisciplinary and innovative solutions for this public health crisis. Perhaps telemedicine can be used to buttress the access to adequate mental health care. More research needs to be done to better identify the barriers individuals encounter in accessing mental health care, both pre- and post-crisis. The goal is that, by identifying the gaps, we can collaboratively bridge them to prevent a preventable death.
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Affiliation(s)
- Mohamed A Hussein
- Division of Trauma Surgery and Surgical Critical Care, Department of General Surgery, Hurley Medical Center, MI, USA
| | - Rohit Nallani
- College of Human Medicine, Michigan State University, MI, USA
| | - Phillip M Jenkins
- Division of Trauma Surgery and Surgical Critical Care, Department of General Surgery, Hurley Medical Center, MI, USA
| | - Robert Stephen Haake
- Division of Trauma Surgery and Surgical Critical Care, Department of General Surgery, Hurley Medical Center, MI, USA
| | - Vinu Perinjelil
- Division of Trauma Surgery and Surgical Critical Care, Department of General Surgery, Hurley Medical Center, MI, USA
| | - James Cranford
- Division of Trauma Surgery and Surgical Critical Care, Department of General Surgery, Hurley Medical Center, MI, USA; Department of Emergency Medicine, University of Michigan Medicine, MI, USA
| | - Amber Campbell
- College of Human Medicine, Michigan State University, MI, USA
| | - Arriona Dryden
- College of Human Medicine, Michigan State University, MI, USA
| | - Sarak Kenney
- College of Human Medicine, Michigan State University, MI, USA
| | - Kaitlin Herdman
- College of Human Medicine, Michigan State University, MI, USA
| | - Amber Dombrowski
- Division of Trauma Surgery and Surgical Critical Care, Department of General Surgery, Hurley Medical Center, MI, USA
| | - Gul Sachwani-Daswani
- Division of Trauma Surgery and Surgical Critical Care, Department of General Surgery, Hurley Medical Center, MI, USA.
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3
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Pham TTL, O’Brien KS, Berecki-Gisolf J, Liu S, Gibson K, Clapperton A. Intentional self-harm in culturally and linguistically diverse communities: A study of hospital admissions in Victoria, Australia. Aust N Z J Psychiatry 2023; 57:69-81. [PMID: 34881672 PMCID: PMC9791328 DOI: 10.1177/00048674211063421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE To examine the rates and profiles of intentional self-harm hospital admissions among people from culturally and linguistically diverse and non-culturally and linguistically diverse backgrounds. METHODS A retrospective analysis of 29,213 hospital admissions for self-harm among people aged 15 years or older in Victoria, Australia, was conducted using data from the Victorian Admitted Episodes Dataset between 2014/2015 and 2018/2019. The Victorian Admitted Episodes Dataset records all hospital admissions in public and private hospitals in Victoria (population 6.5 million). Population-based incidence of self-harm, logistic regression and percentages (95% confidence intervals) were calculated to compare between culturally and linguistically diverse groups by birthplaces and the non-culturally and linguistically diverse groups of self-harm admissions. RESULTS When grouped together culturally and linguistically diverse individuals had lower rates of (hospital-treated) self-harm compared with the non-culturally and linguistically diverse individuals. However, some culturally and linguistically diverse groups such as those originating from Sudan and Iran had higher rates than non-culturally and linguistically diverse groups. Among self-harm hospitalised patients, those in the culturally and linguistically diverse group (vs non-culturally and linguistically diverse group) were more likely to be older, Metropolitan Victorian residents, from the lowest socioeconomic status, and being ever or currently married. Self-harm admissions by persons born in Southern and Eastern Europe were the oldest of all groups; in all other groups number of admissions tended to decrease as age increased whereas in this group the number of admissions increased as age increased. CONCLUSION There was considerable heterogeneity in rates of hospital-treated self-harm in culturally and linguistically diverse communities, with some countries of origin (e.g. Sudan, Iran) having significantly higher rates. Some of this variation may be due to factors relating to the mode of entry into Australia (refugee vs planned migration), and future research needs to examine this possibility and others, to better plan for support needs in the culturally and linguistically diverse communities most affected by self-harm. Combining all culturally and linguistically diverse people into one group may obscure important differences in self-harm. Different self-harm prevention strategies are likely to be needed for different culturally and linguistically diverse populations.
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Affiliation(s)
- Thi Thu Le Pham
- Monash University Accident Research Centre, Monash University, Clayton, VIC, Australia,Thi Thu Le Pham, Monash University Accident Research Centre, Monash University, Clayton, VIC 3800, Australia. ;
| | - Kerry S O’Brien
- School of Social Sciences, Monash University, Melbourne, VIC, Australia
| | | | - Sara Liu
- Monash University Accident Research Centre, Monash University, Clayton, VIC, Australia
| | - Katharine Gibson
- Prevention and Population Health Branch, Public Health Division, The Victorian Department of Health, Melbourne, VIC, Australia
| | - Angela Clapperton
- Centre for Mental Health, Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
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Ismail H, Qadri S, Hussain A. Intentional self-harm in individuals referred to consultation liaison psychiatry services in a tertiary care hospital. J Educ Health Promot 2022; 11:276. [PMID: 36325231 PMCID: PMC9621367 DOI: 10.4103/jehp.jehp_1531_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 02/25/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Intentional self-harm (ISH) is one of the most important entities of consultation-liaison psychiatry. This study aimed to assess the clinical profile of individuals with intentional self-harm referred to consultation-liaison (CL) psychiatric services in a tertiary care hospital. MATERIALS AND METHODS The present study was a cross-sectional hospital-based study, in which purposive sampling was done for sample selection. A total of 60 subjects of ISH referred for evaluation in a tertiary care psychiatry hospital on specified days were recruited to the study after obtaining informed consent. Demographic and clinical details such as the nature of the self-harm attempt, method of attempt, number of attempts, the reason for the attempt, and regret/remorse about the attempt were documented using the semi-structured proforma. RESULTS A total of 60 subjects were included in the study. About 80% of them were below the age of 30 years. The majority (80%) were females, 65% were from a rural background, 56.7% were married. The most common method of ISH was self-poisoning. Interpersonal conflicts with family members (50%), followed by interpersonal conflicts with the spouse/partner (21.7%) were the commonest reason/precipitating factors that lead to intentional self-harm. Also, 45% of our study population did not have any diagnosable psychiatric illness at the time of assessment, and the most common psychiatric diagnosis was personality disorders (20%). CONCLUSION Intentional self-harm is common in young married females from rural backgrounds. Self-poisoning is the most common method of deliberate self-harm. More than half of the individuals were diagnosed with the psychiatric illness at presentation.
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Affiliation(s)
- Haamid Ismail
- Department of Psychiatry, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Sabreena Qadri
- Department of Psychiatry, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Arshad Hussain
- Department of Psychiatry, Government Medical College, Srinagar, Jammu and Kashmir, India
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Rahman M, Leckman-Westin E, Stanley B, Kammer J, Layman D, Labouliere CD, Cummings A, Vasan P, Vega K, Green KL, Brown GK, Finnerty M, Galfalvy H. Predictors of Intentional Self -Harm Among Medicaid Mental Health Clinic Clients In New York. J Affect Disord 2022; 299:698-706. [PMID: 34813869 PMCID: PMC8808564 DOI: 10.1016/j.jad.2021.11.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 10/15/2021] [Accepted: 11/13/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Behavioral health outpatients are at risk for self-harm. Identifying individuals or combination of risk factors could discriminate those at elevated risk for self-harm. METHODS The study population (N = 248,491) included New York State Medicaid-enrolled individuals aged 10 to 64 with mental health clinic services between November 1, 2015 to November 1, 2016. Self-harm episodes were defined using ICD-10 codes from emergency department and inpatient visits. Multi-predictor logistic regression models were fit on a subsample of the data and compared to a testing sample based on discrimination performance (Area Under the Curve or AUC). RESULTS Of N = 248,491 patients, 4,224 (1.70%) had an episode of intentional self-harm. Factors associated with increased self-harm risk were age 17-25, being female and having recent diagnoses of depression (AOR=4.3, 95%CI: 3.6-5.0), personality disorder (AOR=4.2, 95%CI: 2.9-6.1), or substance use disorder (AOR=3.4, 95%CI: 2.7-4.3) within the last month. A multi-predictor logistic regression model including demographics and new psychiatric diagnoses within 90 days prior to index date had good discrimination and outperformed competitor models on a testing sample (AUC=0.86, 95%CI:0.85-0.87). LIMITATIONS New York State Medicaid data may not be generalizable to the entire U.S population. ICD-10 codes do not allow distinction between self-harm with and without intent to die. CONCLUSIONS Our results highlight the usefulness of recency of new psychiatric diagnoses, in predicting the magnitude and timing of intentional self-harm risk. An algorithm based on this finding could enhance clinical assessments support screening, intervention and outreach programs that are at the heart of a Zero Suicide prevention model.
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Affiliation(s)
| | - Emily Leckman-Westin
- New York State Office of Mental Health, NY; Department of Epidemiology and Biostatistics, University at Albany-SUNY, School of Public Health
| | - Barbara Stanley
- New York State Psychiatric Institute, NY; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, NY
| | | | | | - Christa D Labouliere
- New York State Psychiatric Institute, NY; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, NY
| | | | | | | | - Kelly L Green
- Department of Psychiatry Perelman School of Medicine University of Pennsylvania, PA
| | - Gregory K Brown
- Department of Psychiatry Perelman School of Medicine University of Pennsylvania, PA
| | - Molly Finnerty
- New York State Office of Mental Health, NY; Department of Child and Adolescent Psychiatry, New York University Langone Health, NY
| | - Hanga Galfalvy
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, NY; Department of Biostatistics Columbia University Mailman School of Public Health, NY
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6
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Hansen A, Slavova D, Cooper G, Zummer J, Costich J. An emergency department medical record review for adolescent intentional self-harm injuries. Inj Epidemiol 2021; 8:3. [PMID: 33413622 PMCID: PMC7791795 DOI: 10.1186/s40621-020-00293-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 11/24/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Non-suicidal self-injury and suicide attempts are increasing problems among American adolescents. This study developed a definition for identifying intentional self-harm (ISH) injuries in emergency department (ED) records coded with International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes. The definition is based on the injury-reporting framework proposed by the Centers for Disease Control and Prevention. The study sought to estimate the definition's positive predictive value (PPV), and the proportion of ISH injuries with intent to die (i.e., suicide attempt). METHODS The study definition, based on first-valid external cause-of-injury ICD-10-CM codes X71-X83, T14.91, T36-T65, or T71, captured 207 discharge records for initial encounters for ISH in one Kentucky ED. Medical records were reviewed to confirm provider-documented diagnosis for ISH, and identify intent to die or suicide ideation. The PPV of the study definition for capturing provider-documented ISH injuries was reported with its 95% confidence interval (95% CI). RESULTS The estimated PPV for the study definition to capture ISH injuries was 88.9%, 95% CI (83.8%, 92.8%). The estimated percentage of ISH with intent to die was 45.9, 95% CI (47.1, 61.0%). The ICD-10-CM code "suicide attempt" (T14.91) captured only 7 cases, but coding guidelines restrict assignment of this code to cases in which the mechanism of the suicide attempt is unknown. CONCLUSIONS The proposed case definition supported a robust PPV for ISH injuries. Our findings add to the evidence that the current ICD-10-CM coding system and coding guidelines do not allow identification of ISH with intent to die; modifications are needed to address this issue.
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Affiliation(s)
- Anna Hansen
- Kentucky Injury Prevention and Research Center, University of Kentucky, Lexington, KY, USA
- Department of Sociology, University of Kentucky, Lexington, USA
- College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Dessi Slavova
- College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Gena Cooper
- Department of Emergency Medicine, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Jaryd Zummer
- Department of Emergency Medicine, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Julia Costich
- Kentucky Injury Prevention and Research Center, University of Kentucky, Lexington, KY, USA.
- Department of Health Management & Policy, College of Public Health, University of Kentucky, 111 Washington Ave, Lexington, KY, 40536-0003, USA.
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7
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Aslan M, Radhakrishnan K, Rajeevan N, Sueiro M, Goulet JL, Li Y, Depp C, Concato J, Harvey PD. Suicidal ideation, behavior, and mortality in male and female US veterans with severe mental illness. J Affect Disord 2020; 267:144-152. [PMID: 32063566 DOI: 10.1016/j.jad.2020.02.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 12/20/2019] [Accepted: 02/06/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND We compared male and female American veterans with schizophrenia or bipolar disorder regarding clinical characteristics associated with lifetime suicidal ideation and behavior. Subsequent mortality, including death by suicide, was also assessed. METHODS Data from questionnaires and face-to-face evaluations were collected during 2011-2014 from 8,049 male and 1,290 female veterans with schizophrenia or bipolar disorder. In addition to comparing male-female characteristics, Cox regression models-adjusted for demographic information, medical-psychiatric comorbidities, and self-reported suicidal ideation and behavior-were used to examine gender differences in associations of putative risk factors with suicide-specific and all-cause mortality during up to six years of follow-up. RESULTS Women overall were younger, more likely to report a history of suicidal behavior, less likely to be substance abusers, and had lower overall mortality during follow-up. Among women only, psychiatric comorbidity was paradoxically associated with lower all-cause mortality (hazard ratio [HR]=0.53, 95% CI, 0.29-0.96, p = 0.037 for 1 disorder vs. none; HR=0.44, 95% CI, 0.25-0.77, p = 0.004 for ≥2 disorders vs. none). Suicide-specific mortality involved relatively few events, but crude rates were an order of magnitude higher than in the U.S. general and overall veteran populations. LIMITATIONS Incomplete cause-of-death information and low statistical power for male-female comparisons regarding mortality. CONCLUSIONS Female veterans with SMI differed from females in the general population by having a higher risk of suicide attempts. They also had more lifetime suicide attempts than male veterans with same diagnoses. These differences should inform public policy and clinical planning.
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Affiliation(s)
- Mihaela Aslan
- VA Clinical Epidemiology Research Center (CERC), VA Connecticut Healthcare System, West Haven, CT, United States; Department of Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Krishnan Radhakrishnan
- VA Clinical Epidemiology Research Center (CERC), VA Connecticut Healthcare System, West Haven, CT, United States; College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Nallakkandi Rajeevan
- VA Clinical Epidemiology Research Center (CERC), VA Connecticut Healthcare System, West Haven, CT, United States; Yale Center for Medical Informatics, Yale School of Medicine, New Haven, CT, United States
| | - Melyssa Sueiro
- Research Service, Bruce W. Carter Veterans Affairs (VA) Medical Center, Miami, FL, United States
| | - Joseph L Goulet
- Yale Center for Medical Informatics, Yale School of Medicine, New Haven, CT, United States; Pain, Research, Informatics, Multimorbidities, & Education Center, West Haven, CT, United States
| | - Yuli Li
- VA Clinical Epidemiology Research Center (CERC), VA Connecticut Healthcare System, West Haven, CT, United States; Yale Center for Medical Informatics, Yale School of Medicine, New Haven, CT, United States
| | - Colin Depp
- VA San Diego Healthcare System, San Diego, CA, United States; Department of Psychiatry, UC San Diego, La Jolla, CA, United States
| | - John Concato
- VA Clinical Epidemiology Research Center (CERC), VA Connecticut Healthcare System, West Haven, CT, United States; Department of Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Philip D Harvey
- Research Service, Bruce W. Carter Veterans Affairs (VA) Medical Center, Miami, FL, United States; Department of Psychiatry, University of Miami Miller School of Medicine, Miami, FL, United States.
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8
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Yeh ST, Ng YY, Wu SC. Association of psychiatric and physical illnesses with suicide in older adults in Taiwan. J Affect Disord 2020; 264:425-429. [PMID: 31767216 DOI: 10.1016/j.jad.2019.11.070] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 09/17/2019] [Accepted: 11/12/2019] [Indexed: 01/24/2023]
Abstract
OBJECTIVE This study aimed to investigate the association of psychiatric and physical illnesses with suicide in older adults in Taiwan. METHODS A nationwide database in Taiwan was used for this matched case-control study. Elderly participants with and without intentional self-harm from 2010 to 2012 were matched by propensity score by calendar year, gender, age, and area of residence. Psychiatric and physical illnesses were identified by tracing back 1 year from the date of death in suicide and from July 1 of the previous year to June 30 of the observational year in the controls. Associations between illnesses and the risk of suicide was assessed by conditional logistic regression analysis. RESULTS 2,528 older adults who died by suicide were studied, and the crude suicide mortality rate was 33.7 per 100,000. The risk of suicide in older adults with depression (AOR = 9.06, 95% CI = 6.07-13.52), cancer (AOR = 8.51, 95% CI = 5.39-13.45) and schizophrenia (AOR = 7.34, 95% CI = 2.65-20.33), were significantly higher than control group. Other illnesses, such as bipolar disorder, chronic obstructive pulmonary disease, stroke, chronic kidney disease, hypertension, and diabetes mellitus (AOR = 3.63, 2.41, 1.94, 1.73, 1.68, 1.45, respectively), showed lower risk but still significantly higher in older adults with suicide. CONCLUSIONS Psychiatric and physical illnesses, especially depression, cancer, and schizophrenia, were found to be independently associated with suicide in older adults. The result of this study can help clinicians to identify older adults at risk of suicide and open avenues for prevention.
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Affiliation(s)
- Shin-Ting Yeh
- College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.
| | - Yee-Yung Ng
- Department of Medicine, School of Medicine, Fu Jen Catholic University, Taipei, Taiwan.
| | - Shiao-Chi Wu
- Institute of Health & Welfare Policy, National Yang-Ming University, 155, Sec. 2, Li-Nong Street, Taipei, Taiwan 112, Republic of China.
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9
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Clapperton AJ. Identifying typologies among persons admitted to hospital for non-fatal intentional self-harm in Victoria, Australia. Soc Psychiatry Psychiatr Epidemiol 2019; 54:1497-1504. [PMID: 31312852 DOI: 10.1007/s00127-019-01747-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 07/10/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim of this study was to determine whether people who have been hospitalised as the result of non-fatal self-harm form meaningful groups based on mechanism of injury, and demographic and mental health-related factors. METHODS A retrospective analysis of 18,103 hospital admissions for self-harm in Victoria, Australia over the 3-year period 2014/2015-2016/2017 recorded on the Victorian Admitted Episodes Dataset (VAED). The VAED records all hospital admissions in public and private hospitals in Victoria. The primary analysis used a two-step method of cluster analysis. Initial analysis determined two distinct groups, one composed of individuals who had a recorded mental illness diagnosis and one composed of individuals with no recorded mental illness diagnosis. Subsequent cluster analysis identified four subgroups within each of the initial two groups. RESULTS Within the diagnosed mental illness subgroups, each subgroup was characterised by a particular mental disorder or a combination of disorders. Within the no diagnosis of mental illness groups, the youngest group was also the most homogenous (all females who self-poisoned), the oldest group had a high proportion of rural/regional residents, the group with the highest proportion of males also had the highest proportion of people who used cutting as the method of self-harm, and the group with the highest proportion of metropolitan residents also had the highest proportion of people who were married. CONCLUSIONS Preventative interventions need to take into account that those who are admitted to hospital for self-harm are a heterogeneous group.
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Affiliation(s)
- Angela J Clapperton
- Victorian Injury Surveillance Unit, Monash University Accident Research Centre, 21 Alliance Lane, Melbourne, VIC, 3800, Australia.
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10
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Arachchi NSM, Ganegama R, Husna AWF, Chandima DL, Hettigama N, Premadasa J, Herath J, Ranaweera H, Agampodi TC, Agampodi SB. Suicidal ideation and intentional self-harm in pregnancy as a neglected agenda in maternal health; an experience from rural Sri Lanka. Reprod Health 2019; 16:166. [PMID: 31729997 PMCID: PMC6858764 DOI: 10.1186/s12978-019-0823-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 10/09/2019] [Indexed: 01/07/2023] Open
Abstract
Background Suicide only present the tip of the iceberg of maternal mental health issues. Only a fraction of pregnant women with suicidal ideation proceeds to intentional self-harm (ISH) and even a smaller proportion are fatal. The purpose of the present study was to determine the prevalence of depression, suicidal ideation (present and past) and history of ISH among pregnant mothers in rural Sri Lanka. Methods We have conducted a hospital based cross sectional study in the third largest hospital in Sri Lanka and an another tertiary care center. Pregnant women admitted to hospital at term were included as study participants. The Edinburgh Postpartum Depression Scale (EPDS), a self-administered questionnaire for demographic and clinical data and a data extraction sheet to get pregnancy related data from the pregnancy record was used. Results The study sample consisted of 475 pregnant women in their third trimester. For the tenth question of EPDS “the thought of harming myself has occurred to me during last seven days” was answered as “yes quite a lot” by four (0.8%), “yes sometimes” by eleven (2.3%) and hardly ever by 13 (2.7%). Two additional pregnant women reported that they had suicidal ideation during the early part of the current pregnancy period though they are not having it now. Four (0.8%) pregnant women reported having a history of ISH during the current pregnancy. History of ISH prior to this pregnancy was reported by eight women and five of them were reported to hospitals, while others were managed at home. Of the 475 pregnant females included in the study, 126 (26.5%) had an EPDS score more than nine, showing probable anxiety and depression. Pregnant women who had primary/post-primary or tertiary education compared to those who were in-between those two categories were at higher risk of high EPDS score with a OR of 1.94 (95% CI 1.1–3.3). Reported suicidal ideation prior to pregnancy was also associated with high EPDS with a OR of 6.4 (95% CI 2.3–17.5). Conclusions Based on our data, we conservatively estimate around 500 pregnant women each year having suicidal ideation and, 130 ISH annually in Anuradhapura, which should be considered as a high priority for an urgent intervention.
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Affiliation(s)
- Nimna Sachini Malawara Arachchi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Ranjan Ganegama
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Abdul Wahib Fathima Husna
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Delo Lashan Chandima
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Nandana Hettigama
- Department of Obstetrics and Gynecology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | | | | | | | - Thilini Chanchala Agampodi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Suneth Buddhika Agampodi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka.
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11
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Stevens GJ, Hammond TE, Brownhill S, Anand M, de la Riva A, Hawkins J, Chapman T, Baldacchino R, Micallef JA, Andepalli J, Kotak A, Gunja N, Page A, Gould G, Ryan CJ, Whyte IM, Carter GL, Jones A. SMS SOS: a randomized controlled trial to reduce self-harm and suicide attempts using SMS text messaging. BMC Psychiatry 2019; 19:117. [PMID: 30999952 PMCID: PMC6471753 DOI: 10.1186/s12888-019-2104-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 04/05/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Hospital-treated deliberate self-harm (DSH) is common, costly and has high repetition rates. Since brief contact interventions (BCIs) may reduce the risk of DSH repetition, we aim to evaluate whether a SMS (Short Message Service) text message Intervention plus Treatment As Usual (TAU) compared to TAU alone will reduce hospital DSH re-presentation rates in Western Sydney public hospitals in Australia. METHODS/DESIGN Our study is a 24-month randomized controlled trial (RCT). Adult patients who present with DSH to hospital emergency, psychiatric, and mental health triage and assessment departments will be randomly assigned to an Intervention condition plus TAU receiving nine SMS text messages at 1, 2, 3, 4, 5, 6, 8, 10 and 12-months post-discharge. Each message will contain telephone numbers for two mental health crises support tele-services. Primary outcomes will be the difference in the number of DSH re-presentations, and the time to first re-presentation, within 12-months of discharge. DISCUSSION This study protocol describes the design and implementation of an RCT using SMS text messages, which aim to reduce hospital re-presentation rates for DSH. Positive study findings would support the translation of an SMS-aftercare protocol into mental health services at minimal expense. TRIAL REGISTRATION AND ETHICS APPROVAL This trial has been registered with the Australian and New Zealand Clinical Trials Registry (Trial registration: ACTRN12617000607370 . Registered 28 April 2017) and has been approved by two Local Health Districts (LHDs). Western Sydney LHD Human Research Ethics Committee approved the study for Westmead Hospital and Blacktown Hospital (Protocol: HREC/16/WMEAD/336). Nepean Blue Mountains LHD Research Governance Office approved the study for Nepean Hospital (SSA/16/Nepean/170).
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Affiliation(s)
- Garry J. Stevens
- 0000 0000 9939 5719grid.1029.aSchool of Social Sciences and Psychology, Western Sydney University (WSU), Kingswood, NSW Australia
| | - Trent E. Hammond
- 0000 0004 0453 1183grid.413243.3Triage and Assessment Centre, Mental Health Centre, Nepean Hospital, Nepean Blue Mountains LHD, Kingswood, NSW Australia
| | - Suzanne Brownhill
- 0000 0001 0180 6477grid.413252.3Consultation Liaison Psychiatry, Westmead Hospital, Western Sydney Local Health District (WSLHD), Westmead, NSW Australia
| | - Manish Anand
- 0000 0001 0180 6477grid.413252.3Consultation Liaison Psychiatry, Westmead Hospital, Western Sydney Local Health District (WSLHD), Westmead, NSW Australia
| | - Anabel de la Riva
- 0000 0001 0180 6477grid.413252.3Consultation Liaison Psychiatry, Westmead Hospital, Western Sydney Local Health District (WSLHD), Westmead, NSW Australia
| | - Jean Hawkins
- 0000 0004 0572 7882grid.460687.bConsultation Liaison Psychiatry, Blacktown Hospital, WSLHD, Blacktown, NSW Australia
| | - Tristan Chapman
- 0000 0004 0453 1183grid.413243.3Triage and Assessment Centre, Mental Health Centre, Nepean Hospital, Nepean Blue Mountains LHD, Kingswood, NSW Australia
| | - Richard Baldacchino
- 0000 0004 0453 1183grid.413243.3Specialist Mental Health Older People Service, Mental Health Centre, Nepean Hospital, NBMLHD, Kingswood, NSW Australia
| | - Jo-Anne Micallef
- 0000 0004 0453 1183grid.413243.3Child and Youth Consultation Liaison, Nepean Hospital, NBMLHD, Kingswood, NSW Australia
| | | | - Anita Kotak
- 0000 0004 0453 1183grid.413243.3Triage and Assessment Centre, Mental Health Centre, Nepean Hospital, Nepean Blue Mountains LHD, Kingswood, NSW Australia
| | - Naren Gunja
- Department of Clinical Pharmacology and Toxicology, Western Sydney Health, Westmead, NSW Australia ,0000 0004 1936 834Xgrid.1013.3Sydney Medical School, University of Sydney, Sydney, NSW Australia
| | - Andrew Page
- Translational Health Research Institute, School of Medicine, WSU, Campbelltown, NSW Australia
| | - Grahame Gould
- 0000 0004 0486 528Xgrid.1007.6Illawarra Institute for Mental Health, University of Wollongong, Wollongong, NSW Australia
| | - Christopher J. Ryan
- 0000 0004 1936 834Xgrid.1013.3Sydney Medical School, University of Sydney, Sydney, NSW Australia
| | - Ian M. Whyte
- Department of Clinical Toxicology and Pharmacology, Calvary Mater Hospital Newcastle, Waratah, NSW Australia ,0000 0000 8831 109Xgrid.266842.cSchool of Medicine and Public Health, Faculty of Health and Medicine, Newcastle University, Callaghan, NSW Australia
| | - Gregory L. Carter
- 0000 0000 8831 109Xgrid.266842.cSchool of Medicine and Public Health, Faculty of Health and Medicine, Newcastle University, Callaghan, NSW Australia
| | - Alison Jones
- 0000 0004 0486 528Xgrid.1007.6Vice Chancellor’s Unit, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW Australia
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12
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Milner A, Witt K, Maheen H, LaMontagne AD. Suicide among emergency and protective service workers: A retrospective mortality study in Australia, 2001 to 2012. Work 2018; 57:281-287. [PMID: 28582946 DOI: 10.3233/wor-172554] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Emergency and protective services personnel (e.g., police, ambulance, fire-fighters, defence, prison and security officers) report elevated levels of job stress and health problems. While population-level research is lacking, there has been some research suggesting suicide rates may be elevated in emergency and protective services. OBJECTIVES This paper compares suicide rates between emergency and protective services occupational groups over a 12-year period (2001-2012) in Australia. METHOD Labour force data was obtained from the 2006 Australian Census. Suicide data was obtained from the National Coroners Information System (NCIS). Negative binomial regression was used to estimate the association between suicide and employment as an emergency or protective service worker (including prison and security officers) over the period 2001-2012, as compared to all other occupations. Information on suicide method was extracted from the NCIS. RESULTS The age-adjusted suicide rate across all emergency and protective service workers was 22.4 (95% CI 19.5 to 25.2) per 100,000 in males and 7.8 in females (95% CI 4.6 to 11.00), compared to 15.5 per 100,000 (95% CI 15.2 to 15.9) for males and 3.4 (95% CI 3.2 to 3.6) for females in other occupations. The highest risk by subgroup was observed among those employed in the defence force, prison officers, and ambulance personnel. The major method of death for all occupational groups was hanging. CONCLUSIONS Our results clearly highlight the need for suicide prevention among emergency and protective service occupations.
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Affiliation(s)
- A Milner
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - K Witt
- Turning Point, Monash University, Fitzroy, Victoria, Australia
| | - H Maheen
- Work, Health, & Wellbeing Unit, Centre for Population Health Research, School of Health & Social Development, Deakin University, Geelong, Victoria, Australia
| | - A D LaMontagne
- Work, Health, & Wellbeing Unit, Centre for Population Health Research, School of Health & Social Development, Deakin University, Geelong, Victoria, Australia
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13
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Li T, Yan M, Sun Q, Anderson GB. Mortality risks from a spectrum of causes associated with wide-ranging exposure to fine particulate matter: A case-crossover study in Beijing, China. Environ Int 2018; 111:52-59. [PMID: 29174689 DOI: 10.1016/j.envint.2017.10.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 10/12/2017] [Accepted: 10/27/2017] [Indexed: 05/28/2023]
Abstract
BACKGROUND Exposure to fine particulate matter (≤2.5μm in aerodynamic diameter; PM2.5) has been shown to be associated with an increased risk of mortality due to cardiovascular, respiratory, and other pulmonary diseases. However, fewer studies have investigated the relationship between ambient PM2.5 and human mortality for a wider range of causes of death, or for more specific causes of death within these broader categories, especially at the high PM2.5 concentrations currently experienced in Chinese megacities. Beijing, China, has a very large population and a wide range of PM2.5 exposures, allowing a prime opportunity to estimate such risks across a broad spectrum of causes, including rarer causes of death. OBJECTIVE To estimate the relative risk of cause-specific mortality associated with PM2.5 for a spectrum of causes of death, as well as characterize the time course of cause-specific mortality following PM2.5 exposure, in a location where PM2.5 concentrations are representative of common exposures in Chinese megacities. METHODS We collected daily data on mortality counts of Beijing residents and Beijing weather and air pollution measurements for January 1, 2009 to December 31, 2012. We used a time-stratified case-crossover study design to estimate the association between ambient PM2.5 concentrations and risk of death from several broad causes of death and from more refined specific causes within these broader categories. Primary results were estimated for risks the day of and the day following exposure (lag 0-1), but the time pattern of associated risk was also explored up to seven days following exposure. RESULTS Increased concentrations of PM2.5 were associated with increased risks at lag days 0-1 of all-cause mortality (0.26% increase per 10μg/m3; 95% confidence interval [CI]: 0.12%-0.39%), non-accidental deaths (0.25%; 95% CI: 0.11%-0.38%), circulatory deaths (0.39%; 95% CI: 0.21%-0.59%), respiratory deaths (0.43%; 95% CI: 0.05%-0.81%), intentional self-harm deaths (1.94%; 95% CI: 0.19%-3.73%) and nervous system deaths (0.9%; 95% CI: -0.2%-2%), although the observed increase was not statistical significant for the final one rarer cause of death. In addition to these five broad death outcomes, risk also increased following PM2.5 exposure at lag days 0-1 for deaths from several specific causes, including most of the specific circulatory causes considered. The largest observed increased risk by far was for one of the rarest causes of death considered, extrapyramidal and movement disorders (2.35%; 95% CI: 0.03%-4.72%). CONCLUSIONS This study indicates that exposure to PM2.5 in a study location more representative of exposures in developing cities is associated with an increased risk of mortality from broad range of causes of death, including some causes rarely studied previously in association with PM2.5 exposure.
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Affiliation(s)
- Tiantian Li
- National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, No.7 PanjiayuanNanli, Chaoyang District, Beijing 100021, China.
| | - Meilin Yan
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO 80523-1681, USA
| | - Qinghua Sun
- National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, No.7 PanjiayuanNanli, Chaoyang District, Beijing 100021, China
| | - G Brooke Anderson
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO 80523-1681, USA
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14
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Sarchiapone M, Iosue M, Carli V, Amore M, Baca-Garcia E, Batra A, Cosman D, Courtet P, Di Sciascio G, Gusmao R, Parnowski T, Pestality P, Saiz P, Thome J, Tingström A, Wojnar M, Zeppegno P, Thorell LH. EUDOR-A multi-centre research program: A naturalistic, European Multi-centre Clinical study of EDOR Test in adult patients with primary depression. BMC Psychiatry 2017; 17:108. [PMID: 28330446 PMCID: PMC5363034 DOI: 10.1186/s12888-017-1246-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 02/24/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Electrodermal reactivity has been successfully used as indicator of interest, curiosity as well as depressive states. The measured reactivity depends on the quantity of sweat secreted by those eccrine sweat glands that are located in the hypodermis of palmar and plantar regions. Electrodermal hyporeactive individuals are those who show an unusual rapid habituation to identical non-significant stimuli. Previous findings suggested that electrodermal hyporeactivity has a high sensitivity and a high specificity for suicide. The aims of the present study are to test the effectiveness and the usefulness of the EDOR (ElectroDermal Orienting Reactivity) Test as a support in the suicide risk assessment of depressed patients and to assess the predictive value of electrodermal hyporeactivity, measured through the EDOR Test, for suicide and suicide attempt in adult patients with a primary diagnosis of depression. METHODS AND DESIGN 1573 patients with a primary diagnosis of depression, whether currently depressed or in remission, have been recruited at 15 centres in 9 different European countries. Depressive symptomatology was evaluated through the Montgomery-Asberg Depression Scale. Previous suicide attempts were registered and the suicide intent of the worst attempt was rated according to the first eight items of the Beck Suicide Intent Scale. The suicide risk was also assessed according to rules and traditions at the centre. The EDOR Test was finally performed. During the EDOR Test, two fingers are put on gold electrodes and direct current of 0.5 V is passed through the epidermis of the fingers according to standards. A moderately strong tone is presented through headphones now and then during the test. The electrodermal responses to the stimuli represent an increase in the conductance due to the increased number of filled sweat ducts that act as conductors through the electrically highly resistant epidermis. Each patient is followed up for one year in order to assess the occurrence of intentional self-harm. DISCUSSION Based on previous studies, expected results would be that patients realizing a suicide attempt with a strong intent or committing suicide should be electrodermally hyporeactive in most cases and non-hyporeactive patients should show only few indications of death intent or suicides. TRIAL REGISTRATION The German Clinical Trials Register, DRKS00010082 . Registered May 31st, 2016. Retrospectively registered.
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Affiliation(s)
- Marco Sarchiapone
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy. .,National Institute for Health, Migration and Poverty (NIHMP), Rome, Italy.
| | - Miriam Iosue
- 0000000122055422grid.10373.36Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | - Vladimir Carli
- National Centre for Suicide Research and Prevention of Mental lll-Health (NASP), Karolinska Institutet, Solna, Sweden
| | - Mario Amore
- 0000 0001 2151 3065grid.5606.5Clinica Psichiatrica, DINOGMI, University of Genoa, Genoa, Italy
| | - Enrique Baca-Garcia
- 0000000119578126grid.5515.4Department of Psychiatry, Fundacion Jimenez Diaz University Hospital, Autonomous University of Madrid, Madrid, Spain
| | - Anil Batra
- 0000 0001 0196 8249grid.411544.1Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Tuebingen, Germany
| | - Doina Cosman
- 0000 0004 0571 5814grid.411040.0Clinical Psychology and Mental Health Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Philippe Courtet
- 0000 0000 9961 060Xgrid.157868.5Department of psychiatry and medical psychology, University Hospital of Montpellier, Montpellier, France
| | - Guido Di Sciascio
- 0000 0001 0120 3326grid.7644.1Department of Medical Basic Sciences, Neuroscience and Sense Organs, University of Bari, Bari, Italy
| | - Ricardo Gusmao
- 0000 0001 1009 677Xgrid.414462.1Centro Hospitalar de LisboaOcidental (CHLO), Lisbon, Portugal
| | - Tadeusz Parnowski
- 0000 0001 2237 2890grid.418955.42nd Psychiatric Department, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Peter Pestality
- National Institute of Psychiatry and Addictions, Budapest, Hungary
| | - Pilar Saiz
- 0000 0001 2164 6351grid.10863.3cDepartment of Psychiatry, University of Oviedo, Oviedo, Spain
| | - Johannes Thome
- 0000000121858338grid.10493.3fKlinikfür Psychiatrie und Psychotherapie der Universität Rostock, Rostock, Germany
| | - Anders Tingström
- 0000 0001 0930 2361grid.4514.4Psychiatric Neuromodulation Unit, Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden ,0000 0004 0623 9987grid.412650.4Psychiatric Neuromodulation Unit (PNU), Department of Clinical Neuroscienses, Malmö University Hospital, Malmö, Sweden
| | - Marcin Wojnar
- 0000000113287408grid.13339.3bDepartment of Psychiatry, First Faculty of Medicine, Warsaw Medical University, Warsaw, Poland
| | - Patrizia Zeppegno
- 0000000121663741grid.16563.37Department of Translational Medicine, Azienda Ospedaliero Universitaria Maggiore della Carità, University of Piemonte Orientale “Amedeo Avogadro”, Novara, Italy
| | - Lars-Håkan Thorell
- EMOTRA AB, Sävedalen, Sweden ,0000 0001 2162 9922grid.5640.7Linköping University, Linköping, Sweden
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15
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Abstract
BACKGROUND Intentional self- harm (ISH) is one of the commonest yet neglected entities of Consultation liaison Psychiatry. More researches in the field of ISH are needed to effectively manage this problem. AIM To study the socio-demographic and clinical profile of subjects of ISH referred to Psychiatry in a tertiary care hospital. MATERIALS AND METHODS All subjects of ISH referred to department of Psychiatry, of a tertiary centre, on specified days were recruited in to the study after obtaining an informed consent. Socio-demographic details, details of psychiatric assessment were documented using a semi structured proforma. Appropriate management was done. RESULTS Forty one subjects were included in the study. About two third of them belonged to the age group of 18 to 35 years. 56% of them were males, and 71% were married. House wives and students formed a significant proportion of sample. Most common method of ISH was self-poisoning. About two third of the patients had no diagnosable psychiatric illness. Interpersonal conflicts with family members (47%), conflicts with spouse (22%), broken emotional relationship (18%) were common causes for impulsive acts of ISH. CONCLUSIONS ISH is common amongst young, married males. About two third of those who attempt ISH have no diagnosable psychiatric illness, in rest, neurotic stress related disorders, personality disorders and substance use disorders were predominant.
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Affiliation(s)
| | - Anil Nischal
- Department of Psychiatry, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Adarsh Tripathi
- Department of Psychiatry, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Amit Arya
- Department of Psychiatry, King George Medical University, Lucknow, Uttar Pradesh, India
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16
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Moore SE, Scott JG, Ferrari AJ, Mills R, Dunne MP, Erskine HE, Devries KM, Degenhardt L, Vos T, Whiteford HA, McCarthy M, Norman RE. Burden attributable to child maltreatment in Australia. Child Abuse Negl 2015; 48:208-220. [PMID: 26056058 DOI: 10.1016/j.chiabu.2015.05.006] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 05/01/2015] [Accepted: 05/06/2015] [Indexed: 06/04/2023]
Abstract
Child maltreatment is a complex phenomenon, with four main types (childhood sexual abuse, physical abuse, emotional abuse, and neglect) highly interrelated. All types of maltreatment have been linked to adverse health consequences and exposure to multiple forms of maltreatment increases risk. In Australia to date, only burden attributable to childhood sexual abuse has been estimated. This study synthesized the national evidence and quantified the burden attributable to the four main types of child maltreatment. Meta-analyses, based on quality-effects models, generated pooled prevalence estimates for each maltreatment type. Exposure to child maltreatment was examined as a risk factor for depressive disorders, anxiety disorders and intentional self-harm using counterfactual estimation and comparative risk assessment methods. Adjustments were made for co-occurrence of multiple forms of child maltreatment. Overall, an estimated 23.5% of self-harm, 20.9% of anxiety disorders and 15.7% of depressive disorders burden in males; and 33.0% of self-harm, 30.6% of anxiety disorders and 22.8% of depressive disorders burden in females was attributable to child maltreatment. Child maltreatment was estimated to cause 1.4% (95% uncertainty interval 0.4-2.3%) of all disability-adjusted life years (DALYs) in males, and 2.4% (0.7-4.1%) of all DALYs in females in Australia in 2010. Child maltreatment contributes to a substantial proportion of burden from depressive and anxiety disorders and intentional self-harm in Australia. This study demonstrates the importance of including all forms of child maltreatment as risk factors in future burden of disease studies.
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Affiliation(s)
- Sophie E Moore
- School of Public Health, University of Queensland, Herston, QLD, Australia
| | - James G Scott
- Metro North Mental Health, Royal Brisbane and Women's Hospital, Herston, QLD 4029 Australia; The University of Queensland Centre for Clinical Research, Herston, QLD 4029 Australia
| | - Alize J Ferrari
- School of Public Health, University of Queensland, Herston, QLD, Australia; Queensland Centre for Mental Health Research, Wacol, QLD, Australia; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Ryan Mills
- Department of Paediatrics, Logan Hospital, Metro South Hospital and Health Service, QLD, Australia; School of Medicine, University of Queensland, Herston, QLD, Australia
| | - Michael P Dunne
- Children and Youth Research Centre, School of Public Health and Social Work, Queensland University of Technology, QLD, Australia
| | - Holly E Erskine
- School of Public Health, University of Queensland, Herston, QLD, Australia; Queensland Centre for Mental Health Research, Wacol, QLD, Australia; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Karen M Devries
- Gender Violence and Health Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Louisa Degenhardt
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; University of New South Wales, National Drug and Alcohol Research Centre, Sydney, NSW, Australia; Melbourne School of Population and Global Health, University of Melbourne, Melbourne VIC 3010, Australia
| | - Theo Vos
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Harvey A Whiteford
- School of Public Health, University of Queensland, Herston, QLD, Australia; Queensland Centre for Mental Health Research, Wacol, QLD, Australia; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Molly McCarthy
- School of Criminology and Criminal Justice, Griffith University, Australia
| | - Rosana E Norman
- Institute of Health and Biomedical Innovation, Queensland University of Technology, QLD, Australia; School of Public Health and Social Work, Queensland University of Technology, QLD, Australia
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